The 3 Ds of Geriatric Psychiatry: Depression, Delirium, and Dementia

Topics: Apathy | Confusion Assessment Method (CAM) | Delirium | Dementia | Depression | Geriatric Depression Scale (GDS) | MMSE | MOCA | SLUMS

Both common yet elusive, symptoms of depression, dementia, and delirium may overlap in older adults, proving a diagnostic challenge. Even more confounding, these three disorders—the 3 Ds—frequently present simultaneously (Downing LJ et al, Curr Psychiatry Rep 2013;15(6):365). This article will review key features to help distinguish between these di

Low Vitamin B 12 Associated with Depression in Older Adults

Topics: Depression | Folate | Supplementation | Vitamin B12

REVIEW OF: Laird E et al, Br J Nutr 2021;1–22 STUDY TYPE: Prospective cohort study Deficiencies of both vitamin B12 and folate are highly prevalent among older adults. Depending on the study, 5%–40% of adults older than 50 years have B12 deficiency. Folate deficiency ranges from 1.2% among older adults in countries that mandate folate fortific

Does Vitamin B6 Prevent Postpartum Depression?

Topics: Depression | Postpartum Depression | Vitamin B6 | Women's Issues in Psychiatry

REVIEW OF: Khodadad M et al, Int J Prev Med 2021;12:136 STUDY TYPE: Single-blind placebo-controlled trial Postpartum depression (PPD) is common, occurring in about one in eight women and adversely affecting children and families. Treatments are limited, but some lines of evidence hint at a potential role for vitamin B6. For example, vitamin B6 lev

Antidepressants for Suicidal Ideation in Depressed Patients?

Topics: Antidepressant | Cognitive Behavioral Therapy | Depression | Suicidality

REVIEW OF: Dunlop BW et al, Psychol Med 2019;49(11):1869–1878 TYPE OF STUDY: Post-hoc analysis of a randomized controlled trial Antidepressants and cognitive behavior therapy (CBT) appear roughly equivalent for treating depression (Weitz ES et al, JAMA Psychiatry 2015;72(11):1102–1109), but might they differ in their efficacy for individual sy

Quetiapine Reconsidered

Topics: Antipsychotics | Anxiety | Bipolar Depression | Depression | Dosing | Psychopharmacology | Psychopharmacology Tips | PTSD | Quetiapine | Schizophrenia

It is the best of drugs; it is the worst of drugs. Quetiapine (Seroquel) has benefits in some disorders that are unmatched by other medications, but it is also one of the most difficult antipsychotics to tolerate. In this article, I’ll look at where this medication fits and whether its numerous off-label uses are justifiable, including PTSD, generaliz

Psychosis During Depression

Topics: Antipsychotics | Depression | Psychosis

TCPR: Is psychotic depression difficult to diagnose? Dr. Swartz: Psychotic depression is often missed and often misdiagnosed. A study of hospital units at four academic medical centers found that one in three cases of psychotic depression were missed (Rothschild AJ et al, J Clin Psychiatry 2008;69(8):1293–1296). This is important because these pati

Uncommon Tips: Which Is Better—Citalopram or Escitalopram?

Topics: Anxiety | Citalopram | Depression | Escitalopram | SSRIs

Editor’s note: We’re pleased to introduce the new feature “Uncommon Tips.” In this series, Dr. Aiken will discuss little-known pearls about commonly used medications. The series starts with a comparison of citalopram and escitalopram. The rivalry between these two SSRIs began in 2002 when the Lundbeck pharmaceutical company split citalopram (

Can TMS Turn on the Switch?

Topics: Depression | rTMS | TMS | Transcranial Magnetic Stimulation | Treatment-Resistant Depression

REVIEW OF: Miuli A et al, World J Psychiatry 2021;11(8):477–490 STUDY TYPE: Literature review and meta-analysis Some treatments for depression, particularly antidepressants, present risk of manic reactions, but whether this risk exists with transcranial magnetic stimulation (TMS) is less clear. A group in Italy searched the world’s literatu

Hypothyroidism and Depression: Just How Related Are They?

Topics: Depression | Medical Comorbidities | Meta-analysis

REVIEW OF: Bode H et al, JAMA Psychiatry 2021;78(12):1375–1383 STUDY TYPE: Meta-analysis of epidemiologic and population-based studies Hypothyroidism and depression are related, right? Actually, the connection is not so clear. Prior studies have supported a connection, but they had limitations, such as small sample sizes, patients with severe di

An Update on Neuromodulation Techniques for Older Adults

Topics: Anxiety | Deep brain stimulation (DBS) | Dementia | Depression | ECT | Electroconvulsive therapy | magnetic seizure therapy (MST) | mild cognitive impairment | Neuromodulation | Obsessive compulsive disorder/OCD | Personality Disorders | SAINT protocol | Theta burst stimulation | TMS | Transcranial direct current stimulation (TDCS) | Transcranial Magnetic Stimulation | Vagus nerve stimulation (VNS)

CGPR: One of the more interesting neuromodulation interventions is magnetic seizure therapy (MST). How does it work? Dr. Lisanby: MST is an investigational form of treatment for depression. Similar to electroconvulsive therapy (ECT), MST induces seizures with the intention of therapeutic benefit, but the big difference between MST and ECT is how the se

Methylphenidate Improves Mood and Boredom in Children with ADHD

Topics: ADHD | Boredom | Depression | methylphenidate | Mood

REVIEW OF: Golubchik P et al, J Child Adolesc Psychopharmacol 2021;31(4):310–314 TYPE OF STUDY: Open label, ­uncontrolled We are always looking for new angles to understand the conditions we treat. ADHD leads to significant academic and social impairments and is highly comorbid with depression and “boredom.” This study examines these associatio

Electroconvulsive Therapy: A Primer

Topics: brief pulse | Depression | ECT | Innovations | Ketamine | maintenance ECT | memory loss | retrograde amnesia | Stigma | Suicidality | TMS | unilateral vs bilateral

CHPR: Welcome, Dr. Seiner. Can you tell us what led to your interest in electroconvulsive therapy (ECT) and neurotherapeutics? Dr. Seiner: I went to the University of Michigan and got a degree in chemical engineering, but I decided I didn’t want to fractionate oil for a living, so I went to medical school thinking I would be an internist. While in me

Intravenous Ketamine for Teen Depression

Topics: adolescents | Depression | Free Articles | Ketamine | Suicidality

REVIEW OF: Dwyer JB et al, Am J Psychiatry 2021;178(4):352–362 TYPE OF STUDY: Randomized midazolam-controlled trial Treatment-resistant depression (TRD) is a growing concern in teenagers. Although intravenous ketamine has shown clear and immediate improvement of TRD in adults, there is little research to show its effectiveness in teens, and each

The Role of rTMS in Poststroke Depression

Topics: Depression | Post-stroke depression | rTMS | Stroke | TMS | Transcranial Magnetic Stimulation | treatment

REVIEW OF: Hordacre B et al, J Neurol 2021;268(4):1474–1484 STUDY TYPE: Randomized controlled trial Poststroke depression is common, disabling, and often treatment refractory. We know repetitive transcranial magnetic stimulation (rTMS) is effective for treatment-resistant depression. Might it offer a safe and effective treatment for poststroke d

Can We Treat Depression by Targeting Inflammation?

Topics: Antibiotic | Depression | Inflammation | Minocycline | Mood | Pharmacotherapy

REVIEW OF: Zazula R et al, Aust N Z J Psychiatry 2021;55(8):784–798 Recent data suggest inflammation may play a role in depression, prompting research into the efficacy of minocycline—a tetracycline antibiotic with anti-inflammatory effects—as an augmentation agent in the treatment of major depressive disorder (MDD). This study was a pooled

Psilocybin: The New Holy Grai­l for the Rapid Relief of Major ­Depression?

Topics: Depression | Ketamine | Mood | Pharmacotherapy | Psilocybin | Rapid-acting

Review of: Davis AK et al, JAMA ­Psychiatry 2020:e203285 Intravenous ketamine and intranasal esketamine (Spravato) offer hope in the search for a rapidly acting antidepressant. However, concerns regarding addiction, safety, and effect durability have prompted searches for alternative rapid-acting treatments. Psilocybin is a hallucinogen originally d

SSRIs and Intracerebral Hemorrhage Risk

Topics: Bleeding | Citalopram | Depression | Escitalopram | Fluoxetine | Geriatric | Hemorrhagic | Intra-cerebral hemorrhage | Mortality | Paroxetine | Post-stroke depression | Prozac | Serotonin Specific Reuptake Inhibitors (SSRIs) | Sertraline | SSRIs | Stroke

REVIEW OF: Kubiszewski P et al, JAMA Neurol 2020;e203142. Epub ahead of print. Depression after strokes is very common, affecting about 50% of stroke patients. Many such patients are treated with SSRIs, which are generally effective but potentially dangerous because they can increase the risk of bleeding due to impaired platelet aggregation. This is

Can Antidepressants Prolong Survival in Cancer Patients?

Topics: Adherence | Cancer | Citalopram | Depression | Escitalopram | Fluoxetine | Mortality | Paroxetine | Prozac | Serotonin Specific Reuptake Inhibitors (SSRIs) | Sertraline | SSRIs

Review Of: Shoval G et al, Depress Anxiety 2019;36(10):921–929 Many cancer patients experience depression, especially those with poor prognoses. Compared with euthymic patients, depressed cancer patients are less adherent to their cytotoxic medications, and this poor adherence can worsen their long-term survival. Yet surprisingly, some studies have

Intranasal Esketamine: New Hope for Suicidal Patients?

Topics: Depression | Esketamine | Fast-acting | Free Articles | Intra-nasal | Ketamine | Management | Psychopharmacology | Suicidality

It’s likely your patients have asked you about esketamine. The buzz is that it’s a rapid-acting miracle cure for suicidal depression. Dr. Thomas Insel, former director of NIMH, declared that ketamine “might be the most important breakthrough in antidepressant treatment in decades” (www.nimh.nih.gov/about/directors/thomas-insel/blog/2014/ketamine

Duty to Warn? Debating Antidepressant Suicidality

Topics: adolescents | Antidepressants | children | Depression | emergent suicidality

CCPR: We are here with Dr. Ignaszewski and Dr. Spielmans to review the latest on emergent suicidality in children and adolescents during antidepressant treatment. Dr. Spielmans, please give us the context of this issue and how your recent article fits in (Spielmans GI, Spence-Sing T, and Parry P, Front Psychiatry 2020;11:18). Dr. Spielmans: In 2004, th